Challenges and barriers to improving care of the musculoskeletal patient of the future - a debate article and global perspective

Abstract

BackgroundWith greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic surgeons.Hence, it functions more as a forum-based rather than a scientific-based presentation. This exposé was designed to stimulate debate about the emerging patients' needs in the future predicted by leading orthopedic surgeons that provide some hint as to the right direction for orthopedic care and outlines the important topics in this area.DiscussionThe authors aim to provide a general overview of orthopedic care in a typical developed country setting. However, the regional diversity of the United States and every other industrialized nation should be considered as a cofactor that may vary to some extent from our vision of improved orthopedic and trauma care of the musculoskeletal patient on an interregional level.In this forum, we will define the current and future barriers in developed countries related to musculoskeletal trauma, total joint arthroplasty, patient safety and injuries related to military conflicts, all problems that will only increase as populations age, become more mobile, and deal with political crisis.SummaryIt is very likely that the future will bring a more biological approach to fracture care with less invasive surgical procedures, flexible implants, and more rapid rehabilitation methods. This international consortium challenges the trauma and implants community to develop outcome registries that are managed through health care offices and to prepare effectively for the many future challenges that lie in store for those who treat musculoskeletal conditions.

Hard Tissue: shaping minds for the future

“…What is hard in studying is often enjoyable and worth excelling in. The ability to turn symptoms into the right diagnosis and into treatment plan rapidly is what eventually makes a good clinician [3][4][5][6] .…”

“…The introduction of joint replacement (arthroplasty) surgery has specifically led to improved quality of life of our aged population 10 . Spinal disorders now can be managed appropriately with minimal morbidity with the advances of orthopaedic sciences [3][4][5][6][7] . Sport injuries are another important branch of orthopaedic surgery, which has advanced with the growing interest in fitness and sports in this age 5 .…”

“…Without doubt, the advancement in this discipline has led to significant improvement in the quality of life of significant portion of the population [3][4][5][6][7] . Scientific and systematic approach to polytrauma patients has led to a significant decrease in morbidity and mortality in this cohort 8,9 .…”

“…Several new technologies have been introduced which led to advances in the field of tissue engineering and molecular biology, biophysics, stem cells, mechanics and regeneration and nanotechnology [1][2][3][4][5][6][7][40][41][42] . The introduction of optical technology (including lasers, optical diagnostics and photodynamic therapy) has led to major advances in this area of sciences including early diagnosis and management of tumours and management of wound infections and tissue healing 15,17,[39][40][41][42] .…”

Physician involvement in the care of multiply injured patients: the role of guidelines and subspecialties

“…Although experts in their fields of interest, clinicians today may have to consult many other services to achieve a complete overview of the patient's condition. Further differentiation may be useful in the future, depending on the challenges of our future patients [6].…”